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Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing's syndrome: a systematic review of the literature.
[cushing syndrome]
The
postoperative
course
of
patients
with
subclinical
hypercortisolism
(
SH
)
is
yet
to
be
clarified
.
The
aims
are
to
review
the
prevalence
and
predictive
factors
of
postoperative
adrenal
insufficiency
and
the
time
to
recover
a
normal
adrenocortical
function
in
patients
with
SH
and
Cushing
's
syndrome
(
CS
)
.
Using
the
PubMed
database
,
we
conducted
a
systematic
review
of
the
literature
,
selecting
studies
published
from
1980
to
2013
.
Of
the
1522
papers
screened
,
28
were
selected
(
13
retrospective
,
14
prospective
,
and
one
randomized
controlled
trial
)
.
The
prevalence
of
postoperative
adrenal
insufficiency
was
65
.
3
%
in
248
SH
subjects
and
99
.
7
%
in
377
CS
patients
.
Patients
with
SH
were
reclassified
according
to
the
following
diagnostic
criteria
:
subjects
defined
by
pathological
dexamethasone
test
only
(
DEX
)
,
and
those
defined
by
the
dexamethasone
test
with
one
(
DEX
+
1
)
or
two
additional
criteria
(
DEX
+
2
)
;
and
they
were
compared
with
CS
patients
.
The
prevalence
of
adrenal
insufficiency
was
51
.
4
,
60
.
6
,
91
.
3
,
and
99
.
7
%
,
respectively
,
with
no
significant
difference
between
the
two
latter
groups
.
The
test
with
the
best
compromise
between
sensitivity
(
64
%
)
and
specificity
(
81
%
)
in
predicting
adrenal
insufficiency
was
the
midnight
serum
cortisol
.
The
time
to
achieve
eucortisolism
was
lower
in
SH
patients
than
in
CS
patients
(
6
.
5
vs
11
.
2
mo
;
P
<
.
001
)
.
Adrenal
insufficiency
occurs
in
about
half
of
the
patients
with
SH
if
defined
only
by
the
pathological
dexamethasone
test
.
However
,
prevalence
of
adrenal
insufficiency
and
time
to
recovery
are
tightly
related
to
the
degree
of
hypercortisolism
and
diagnostic
criteria
to
define
SH
,
which
might
help
to
better
define
SH
for
future
studies
.
Diseases
Validation
Diseases presenting
"hypercortisolism"
symptom
adrenal incidentaloma
aromatase deficiency
cushing syndrome
This symptom has already been validated
